Q: What are the blue HCC icons that appear when I am searching the master problem dictionary in the ACI?

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As of January 1, 2007 payments to Medicare Managed Care plans are based 100% on a diagnosis classification system called Hierarchical Condition Categories (HCC). The Center for Medicare and Medicaid Services (CMS) introduced this model to adjust Medicare capitation payments to private managed care plans for the health expenditure risk of their enrollees.

Physicians receive higher capitation rates when they include chronic conditions when coding clinical encounters with their patients.

Effective in TouchWorks/Enterprise Version 11.0, the system allows the client to flag ICD-9 diagnoses that belong to an HCC. Based on an enterprise-level preference, the system displays an indicator for HCC-related diagnoses when the patient’s insurance for the encounter is linked to Medicare Managed Care. In addition, the system displays the ‘last submitted’ date for diagnoses on the patient past diagnosis list.

The HCC will appear red until it has been assessed during the calendar year. Once it has been assessed, it will appear with a green check. After that calendar year it will return to red.

For more details click here HCC.


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